Irregular penis curvature while erected may be inborn or of acquired origin. In the latter case, it is called Peyronie's disease, as a reference to the French physician who discovered it.
Penis structure is formed by a tissue recovering the corpora cavernosa called tunica albuginea. On the other hand, elastic fibers integrating the tunica albuginea form an irregular framework on which collagenous fibers lie. These two structural components are essential to penis configuration during erection, as they allow the increase of penis diameter and extension during tumescence. Any defect on collagenous and resilient fibers of the tunica albuginea can lead to significant changes in erection hemodynamics. Erection hemodynamics means, in this application, the movement with which blood runs around the corpora cavernosa in the penis erection process.
The tunica albuginea performs an essential role in erection due to its flexibility and stiffness characteristics. The pPenis maximum length, width and curvature while in erection are determinedby the configuration of the tunica albuginea.
In case of an inborn curved penis, the problem is caused by lack of flexibility of the tunica albuginea and/or its covers. On the other hand, Peyronie's disease is characterized by developing cicatricial tissue on said tunica albuginea, reducing its flexibility.
During erection, the normal side of the penis, the flexibility of which is preserved, presents the usual gain in size, while the affected size, due to a loss in flexibility of the tunica albuginea and/or its covering, does not expand equally, with a consequent curvature towards the same size and loss of penis functional size.
Not only the functional size of the penis is reduced but also, in more severe cases, sexual act practice by man is hidered, keeping him from having a normal life.
Currently existing techniques to correct penis curvature basically consist of (1) reducing the long side of the penis to the size of the short side, or (2) increase the short side of the penis to the same size of the long side.
When the reduction of the long side of the penis to the size of the short side is desired, the following is done: (1) elliptical excision on the tunica albuginea on the opposed side of the penis to that one with the defect, subsequently suturing borders; (2) plication or pleat of the tunica albuginea on the opposed side to that one with the defect, to reduce the long side not resorting, however, to an incision or resection of the tunica albuginea; or (3) lengthwise incision on the longer side followed by crosswise suture.
Said techniques incur a few disadvantages. Firstly, while reducing the long side to the size of the short side, curvature can be corrected, but the patient will be dissatisfied with the reduction of the size of the penis, which will be as extensive as the existing curvature. Therefore, patients are reluctant to accept to accept this kind of surgical procedure. Another disadvantage consists in the fact that the application of said skills do not include an exact determination of the excision place and the size of the ellipse to be taken off or the place and size of lengthwise plication(s), or incision(s) and crosswise suture.
As previously shown, other skills extend the short size of the penis to the same size of the long side. These surgical procedures are made by incision and/or excision of the tunica albuginea by making use of grafts to cover the side which will become longer after being submitted to surgery.
Procedures to extend the short side of the penis overcome the disadvantage of reducing the size of the penis, but incur in other problems as described below.
In about 70% of Peyronie's disease cases, the plate of cicatricial tissue is palpable. At the time of the surgery, the surgeon can feel the plate of cicatricial tissue and determining the place where incision or excision will be made. In 30% of cases, there is no palpable cicatricial tissue during surgery. It is possible that the tunica albuginea is less flexible without alteration of it thickness so as not to be palpable, and it is also known that there are flexibility changes in the tunica farther from the plate, thus explaining cases in which the substitution of plate(s) do not correct penis deformation. Furthermore, there are patients presenting multifocus plates.
Due to the above, surgeries based on cicatricial tissue plates do solve all cases and may not correct penis curvature with its single removal, since the flexibility of the tunica is compromised at a distance of the plate(s).
Therefore, the procedure of excision of plate(s) by itself may not be sufficient to correct penis curvature, and complementary relaxation incisions must be added.
Since the patient's main claim is the penis deformation (and not the plate, when present), it is possible to correct it with the single incision or relaxation incisions (correction by expansion, instead of substitution). By means of a linear incision, it is possible to create a simpler defect on the tunica albuginea, which will be covered by a graft, facilitating the suture procedure.
Another disadvantage of the excision and graft procedures is the high rate of post-surgery erectile dysfunction which, in various studies of the state of the art, are reported as varying between 12% and 100% (Dalkin, B. L.; Carter, M. F., Venogenic Impotence following dermal graft repair for Peyronie's disease, J. Urol., v. 146 (3), p. 849-51, 1991).
Currently, no matter the method to correct penis curvature, more accurate means determine correction are not employed.
When the increase of the short side of the penis is desired with consequent graft application, there is also no accurate procedure determine the dimensions of said defect of the tunica and the corresponding graft. Techniques measure the defect on the tunica with the penis in a flaccid state, under traction, which is not coincident with the defect required to correct the deformity, which is related to the stretched tunica during erection.
Furthermore, for all previously shown surgical skills, it is necessary to keep the penis erect to visualize and determining the location of the incision line, even if there is no accurate method for that. Currently, erection is forced by continuous serum injection within the corpora cavernosa. This injection is made by means of two needle syringes containing serum applied within corpora cavernosa. The problem to effect said practice is the need for the assistants to make the injection and, since there is much serum leakage, the syringe needs to be changed to fill it again with serum. Therefore, the penis will again become flaccid and a new erection will have to be induced determine incision locations. According to one of the alternatives of the invention, the use of an infusion pump allows an stable erection under maximum rigidity, providing a surgery with optimized results.
The invention aims to solve the problems as found in the prior art.
More specifically, an object of the invention is a surgical method to correct penis curvature.
Furthermore, another object of the invention is a geometrical method to accurately determining the most appropriate location of the main incision line to be made in a surgery to correct penis curvature.
Another object of the invention is a geometrical method to accurately determining distribution and the size of the forked ends of the main incision line to be made in a surgery to correct penis curvature.
Another object of the invention is a geometrical method to accurately determining the dimensions of the defect created by the surgery to correct penis curvature when the shorter side of the penis should be extended, aiming at introducing a graft.
One further object of the invention is an auxiliary device to the surgery to correct penis curvature based on the geometrical methods of the invention.